- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.30 / $6,426.50 / $10,453.00
| Facility | | $672.30 | $6,426.50 | $10,453.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $748.70 / $2,710.28
| Facility | | $748.70 | $748.70 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $672.30 / $916.00 / $1,358.46
| Facility | | $672.30 | $916.00 | $1,358.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $115.71 / $128.24 / $212.72
| Facility | AS | $115.71 | $128.24 | $212.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,248.00 / $9,541.00 / $14,589.00
| Facility | | $2,248.00 | $9,541.00 | $14,589.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,244.35 / $8,957.00 / $26,542.00
| Facility | | $3,244.35 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $157.83 / $510.42 / $849.00
| Facility | AS | $157.83 | $510.42 | $849.00 |